Pediatric Mycoplasma Pneumonia: The Radiographic Patterns and Review of the Literature.

PURPOSE: The purpose of the present paper was to evaluate the clinical and chest radiographic features of pediatric patients with serologically proven Mycoplasma pneumoniae pneumonia. MATERIALS AND METHODS: The clinical records and chest radiographs of 55 consecutive patients (28 male, 27 female) with serologically positive IgG mycoplasma pneumonia were reviewed. The pneumonic infiltrates were described on chest radiography into 3 different patterns as a peribronchovascular infiltration, reticulonodular infiltration and consolidation. RESULTS: More than 91% of patients presented with cough and 70% of patients had fever. Chest radiographs displayed three different patterns: (i) peribronchovascular infiltration (n=33, 60%); (ii) reticulonodular infiltration (n=12, 22%); (iii) consolidation (n=10, 18%). Bilateral peribronchovascular infiltration in central and middle lung zones were frequently seen (n=33, 60%). Other radiological features were unilateral lesions in 51% of patients, pleural effusion in 18%, and hilar lymphadenopathy in 20%. CONCLUSION: There are various radiological features of mycoplasma pneumonia in children. Bilateral peribronchovascular infiltration confined to central and middle lung regions seems to be more closely associated with mycoplasma infection.

Thyroid malignancy in children: where does it locate?

Objective: As far as we know, in English literature, a limited number of studies has examined the relationship between the location of the nodule and malignancy risk. The studies were performed with adults and their results were mainly inconsistent. We aim to evaluate the potential association between the location of the thyroid nodules and risk for malignancy in the pediatric population. Materials and methods: Patients younger than 18 years old with a pathological diagnosis were included. Nodules were divided into 5 categories according to the Thyroid Imaging Reporting and Data System (TI-RADS) algorithm. The location of the nodules was recorded: Right lobe, left lobe, isthmus, upper pole, lower pole, and middle. Thyroid glands were divided into 3 equal longitudinal areas to define upper, lower, and middle portions. Results: Ninety-seven nodules of 103 children were included. The mean age of the population was 14.9 ± 2.51 years (7-18 years). Eighty-one participants were female (83.5%) and 16 male (16.5%). Fifty nodules were benign (51.5%) and 47 nodules were malignant (48.5%). We did not detect a significant correlation between the risk of malignancy and location of the nodule as right or left lobes or isthmus (P = 0.38). Rate of malignant nodules were significantly higher in middle lobe (23%, P = 0.002). Being located at middle part of thyroid gland increases the possibility of malignancy 11.3 times (OR = 11.3, P = 0.006). Conclusion: Nodule location can be used as a predictor for thyroid malignancy in pediatric patients, similar to adults. Middle lobe location increases the risk of malignancy. Using nodule location along with TI-RADS categorization can increase the efficacy of malignancy prediction.

Mediastinal lesions in children.

The mediastinum is where thoracic lesions most frequently occur in young patients. The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad. Congenital lesions, infections, benign and malignant lesions, and vascular diseases are examples of lesions. Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly. Our task is currently made simpler by radiological imaging techniques.

Thyroid malignancy in children: where does it locate?

ABSTRACT Objective: As far as we know, in English literature, a limited number of studies has examined the relationship between the location of the nodule and malignancy risk. The studies were performed with adults and their results were mainly inconsistent. We aim to evaluate the potential association between the location of the thyroid nodules and risk for malignancy in the pediatric population. Materials and methods: Patients younger than 18 years old with a pathological diagnosis were included. Nodules were divided into 5 categories according to the Thyroid Imaging Reporting and Data System (TI-RADS) algorithm. The location of the nodules was recorded: Right lobe, left lobe, isthmus, upper pole, lower pole, and middle. Thyroid glands were divided into 3 equal longitudinal areas to define upper, lower, and middle portions. Results: Ninety-seven nodules of 103 children were included. The mean age of the population was 14.9 ± 2.51 years (7-18 years). Eighty-one participants were female (83.5%) and 16 male (16.5%). Fifty nodules were benign (51.5%) and 47 nodules were malignant (48.5%). We did not detect a significant correlation between the risk of malignancy and location of the nodule as right or left lobes or isthmus (P = 0.38). Rate of malignant nodules were significantly higher in middle lobe (23%, P = 0.002). Being located at middle part of thyroid gland increases the possibility of malignancy 11.3 times (OR = 11.3, P = 0.006). Conclusion: Nodule location can be used as a predictor for thyroid malignancy in pediatric patients, similar to adults. Middle lobe location increases the risk of malignancy. Using nodule location along with TI-RADS categorization can increase the efficacy of malignancy prediction.

Clinical and radiologic manifestations of Mycoplasma pneumoniae infection in children.

BACKGROUND: Mycoplasma pneumoniae (MP) is one of the most important etiological agents of communityacquired pneumonia in children. METHODS: The medical records of children with an MP infection between 2008 and 2015 were reviewed for their clinical, laboratory radiological features. RESULTS: This study included 244 patients (male 57.4%) with a median age of 80.5 months (IQR, 46.5-120 months). A total of 78 (32%) patients were < 5 years old, and 166 (68%) were ≥ 5 years old. The most common complaints before admission to the hospital were cough (84.8%), fever (57.4%), and weakness (18.9%). In the < 5 years old age group, oxygen saturation was lower, and tachypnea was more common than in the ≥ 5 years old age group (p=0.02 and p=0.05, respectively). Similarly, the physical findings such as the prolonged expiration, presence of retractions, and rhonchi were more frequent in the < 5 years old age group (p=0.001, p=0.000, p=0.02, respectively). Extrapulmonary manifestations were present in 45 (18.4%) patients, and skin involvement was the most common one (7.7%). Two hundred-thirty-eight (97.5%) patients had chest radiographs, and 45 (18.4%) had normal radiography. The most common radiological involvement was peribronchial infiltration (n=70, 28.7%). Of the patients, 147 (60.2%) were hospitalized, and 97 (39.7%) were followed up as outpatients. It was determined that 156 (63.9%) patients had commenced macrolide empirically, and 61 (25%) patients were treated with positive serology results. CONCLUSIONS: The prolonged fever, cough and expiration time, wheezing and rhonchi in younger children, and segmental-lober consolidation in chest radiography could be clues for MP infection. Further studies in different age groups can facilitate an understanding of MP infection`s epidemic characteristics and clinical features that will provide early diagnosis and appropriate treatment.

Surfactant for a Patient with Refractory Pyopneumothorax and Acute Respiratory Distress Syndrome Due to Pneumococcal Necrotizing Pneumonia Complicated by a Bronchopleural Fistula.

Background: Necrotizing pneumonia rarely occurs in children, but when it does it can be complicated by bronchopleural fistula, empyema, pneumothorax, sepsis, and acute respiratory distress syndrome (ARDS). Antimicrobial therapy is the cornerstone of its management; however, surgery is necessary in some cases. Ideally, surgical interventions are kept to a minimum, but this is not always possible if there is a mass effect from air and fluid in the pleural space, pulmonary necrosis leading to massive hemoptysis, uncontrolled sepsis, or difficulties with assisted ventilation. Case Presentation: Herein we present a patient with refractory pyopneumothorax and ARDS due to pneumococcal necrotizing pneumonia complicated by a bronchopleural fistula. The patient's clinical condition deteriorated despite antibiotics, surgical drainage, and assisted ventilation. Owing to pneumothorax with a high percentage of air leakage, bilateral diffuse collapse of the lungs, and insufficient oxygenation, surgical treatment was considered, but because of the patient's lack of tolerance for surgery due to hemodynamic reasons and the complications associated with surgery, medical treatment was determined to be more appropriate. Surfactant treatment was administered to the patient, resulting in significant clinical improvement. Conclusion: To the best of our knowledge, this is the first report of the use of surfactant to treat ARDS due to necrotizing pneumonia. Based on the presented case, we think surfactant can be considered as a salvage treatment for such patients.

Giant Right Atrial Myxoma with Fulminant Progression in an Infant.

Cardiac myxoma is rare in children. Myxomas are exceedingly rare in infancy. Right atrial myxomas were recorded in a small number of case reports involving infants worldwide. We report the case of a 2-month-old infant with giant right atrial myxoma. The case presented to our hospital with respiratory distress, and had pericardial and pleural effusion. Diagnosis of cardiac tumor was made with the aid of computerized tomography scan and echocardiogram. The tumor size was 3.1 × 3.4 × 3.9 cm. The patient worsened rapidly and had sudden cardiac arrest which did not respond to interventions. Postmortem cardiac autopsy confirmed the diagnosis of myxoma on gross examination and histology. This article aims to focus attention to the atypical size and location of this atrial myxoma, causing diagnostic difficulty in this infant.

Multisystem inflammatory syndrome in children associated with SARS-CoV-2: extracardiac radiological findings.

OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2. METHODS: A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months-15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3. RESULTS: The most common finding on chest radiographs was perihilar-peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C. CONCLUSION: Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings. ADVANCES IN KNOWLEDGE: The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.

Successful management of acute pancreatitis due to apolipoprotein C-II deficiency in a 37-day-old infant.

Familial chylomicronemia is caused by deficiency of lipoprotein lipase or its co-activators. Here, we report an infant with apolipoprotein C-II (APOC2) deficiency, who developed acute pancreatitis 37 days after birth. He presented as abdominal sepsis with fever, irritability and abdominal distention. Amylase levels were low, but lipase levels and imaging findings were consistent with acute pancreatitis. He had severe hypertriglyceridemia (1091 mg/dl). Keeping him nil orally for two days resulted in rapid decrease in triglyceride levels and resolution of the clinical findings. APOC2 gene sequencing revealed a homozygous splice-site mutation (c.55+1G>C). To the best of our knowledge, this patient is not only the youngest reported patient with APOC2 deficiency, but also the youngest such patient who developed pancreatitis. Although he had a severe presentation, invasive methods to treat hypertriglyceridemia were not necessary. We emphasize that clinical findings and amylase levels are not reliable to diagnose pancreatitis in this age group.

Multifocal mesenchymal hamartoma of the chest wall in a newborn.

Özkale Yavuz Ö, Özcan HN, Çinar HG, Oguz B, Haliloglu M. Multifocal mesenchymal hamartoma of the chest wall in a newborn. Turk J Pediatr 2019; 61: 975-978. Mesenchymal hamartoma of the chest wall is an extremely rare, benign chondro-osseous chest wall tumor which originates from one or more ribs, in newborns or infants. It usually appears as a solitary lesion but more rarely can be multifocal and bilateral. Sometimes it may mimic chest wall malignant tumors because of its destructive radiological nature. Herein, we aim to present the imaging characteristics of a 4-day-old boy with multifocal mesenchymal hamartoma of the chest wall.

Is color Doppler a reliable method for the diagnosis of malrotation?

PURPOSE: The gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study. METHODS: UGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively. RESULTS: All patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%. CONCLUSION: Current data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.

Ultrasonographic clues for diagnosis of spina bifida occulta in children.

BACKGROUND: The aim of the current study was to find out if spinal ultrasonography might have a predictive potential for detection of spina bifida occulta (SBO) in pediatric nocturnal enuresis patients. METHODS: A total of 108 children (58 females, 50 males) with a mean age of 8 (range, 6-15) years diagnosed for nocturnal enuresis in our tertiary care center were included in this cross-sectional analysis. Half of the cases (n=54, 50%) were found to have SBO, while the other half did not have SBO. After obtaining radiographs and computed tomography examinations of L5-S1 vertebra, patients were examined by spinal ultrasound regarding radiologic clues which may aid in the detection of SBO. RESULTS: The clues of "single and double echogeneous cap signs and the V-shaped tip of spine" were found useful for diagnosing SBO at levels of L5 and S1 in pediatric patients suspected for SBO. Receiver operating curve (ROC) curve analysis of CT and ultrasonographic clues for diagnosis of SBO on S1 level revealed that these clues yielded a comparable diagnostic accuracy to CT. Areas under curve for CT and studied ultrasonographic clues were are 0.667±0.053 and 0.907±0.032 (P<0.001) respectively. CONCLUSIONS: Ultrasonography seems to be a useful and practical diagnostic tool for diagnosing spina bifida. However, to implement our ultrasonographic criteria in routine radiological practice, further studies in larger series are warranted.

Antral gastritis caused by Helicobacter pylori infection in the pediatric age group is associated with increased mesenteric lymph node dimension observed by ultrasonography.

BACKGROUND: To find out if transabdominal ultrasonography (US) may have a predictive role for detection of antral gastritis and Helicobacter pylori (HP) infection in the antrum of pediatric age group. METHODS: A total of 91 (63.6%) patients and 52 (36.4%) controls were allocated into two groups as follows: Group 1 (n=91): patients with complaints and endoscopic findings consistent with gastritis and documented HP infection; Group 2 (n=52): patients with complaints and endoscopic findings consistent with gastritis in the absence of documented HP infection. These two groups were compared in terms of demographics and biggest mesenteric lymph node detected, muscularis mucosa thickness, submucosal thickness, muscularis propria thickness, and total gastric wall thickness. RESULTS: The two groups exhibited no statistically significant difference with respect to age (P=0.747), and presenting symptoms (P=0.982). However, the mesenteric lymph node dimension was significantly increased in Group 1 (P=0.039). Median mesenteric lymph node dimension was 12.9 (±15.4) mm in Group 1, while 11.0 (±12.8) mm in Group 2. No significant difference was observed between groups in terms of muscularis mucosa thickness (P=0.243), submucosal thickness (P=0.174), muscularis propria thickness (P=0.356), and total gastric wall thickness (P=0.223). CONCLUSIONS: Antral gastritis caused by HP infection in the pediatric age group is associated with increased mesenteric lymph node dimension observed by US.

Are there any novel radiological diagnostic clues in magnetic resonance imaging for vertebrobasilar insufficiency?

BACKGROUND: The aim of the current study was to investigate whether signal intensities on magnetic resonance imaging (MRI) views and radiological findings on Doppler ultrasonography may have a diagnostic value for vertebrobasilar insufficiency (VBI). METHODS: This case-control study was performed on demographic and radiologic data derived from 18 VBI patients and 58 healthy controls in the radiology department of a tertiary care center. The blood flow characteristics including peak systolic and end diastolic flow rates, resistance and pulsatility indices, mean velocities, flow rates, diameters and intensity pattern of vertebral arteries on cervical and cranial MRI sequences were noted. The association between blood flow characteristics and signal patterns on MRI views was investigated in VBI patients and controls. RESULTS: Blood flow and vessel diameter were significantly decreased in VBI patients compared to controls on both sides (P<0.001). In contrast, other parameters did not exhibit any remarkable difference between VBI and control groups. The distribution of hypo- or hyperintense signals in VBI and control groups was similar. No remarkable variabilities were detected in blood flow characteristics of cases presenting with signals having different intensities on MRI sequences. CONCLUSIONS: In conclusion, results of the current study have demonstrated that assessment of blood flow and vascular diameter may be important for ruling in VBI. Nevertheless, the intensity of signals derived from vessels seems not reveal any data of diagnostic significance in these cases. Further studies on larger populations may allow development and exploration of newer diagnostic techniques and clues for VBI.

Novel sonographic clues for diagnosis of antral gastritis and Helicobacter pylori infection: a clinical study.

OBJECTIVES: The purpose of this study was to find out whether transabdominal sonography may have a predictive role for detection of antral gastritis and Helicobacter pylori infection in the antrum. METHODS: A total of 108 patients and 54 control participants were allocated into 3 groups: group 1, controls without any symptoms or findings of antral gastritis and H pylori infection; group 2, patients with symptoms and endoscopic findings consistent with gastritis in the absence of documented H pylori infection; and group 3, patients with symptoms and endoscopic findings consistent with gastritis and documented H pylori infection. These groups were compared in terms of demographics, antral wall thickness, mucosal layer (together with muscularis mucosa) thickness, and mucosal layer-to-antral wall thickness ratio. RESULTS: The groups had no statistically significant differences with respect to age, sex, body mass index, and smoking habits. However, it turned out that both antral walls and muscularis mucosa layers were thicker and the mucosal layer-to-antral wall thickness ratio was higher in groups 2 and 3 compared to group 1 (P > .001). In addition, group 3 had statistically significantly thicker antral walls and muscularis mucosa layers and a significantly increased mucosal layer-to-antral wall thickness ratio than group 2 (P < .001). CONCLUSIONS: Our results suggest that antral gastritis caused by H pylori infection is associated with characteristic features such as thickening of antral walls and mucosal layers on sonography. These novel clues may be useful in the diagnosis of gastritis, and unnecessary interventions and measures can be avoided in some cases.

Fibrinolytic therapy of thrombosis in 27 newborns followed-up in neonatal intensive care unit.

BACKGROUND AND AIM: We aimed to report newborns with thrombosis and needed fibrinolytic treatment. PATIENTS AND METHODS: This was a retrospective study conducted on 27 newborns with thrombosis followed-up in a neonatal intensive care unit between December 2007 and December 2012. The patients were divided into two groups according to treatment protocol; Group 1 (n = 15): recombinant tissue-type plasminogen activator (r-tPA) and Group 2 (n = 12): streptokinase (STK). The groups were compared in terms of the efficacy and complications of the treatments. RESULTS: In Group 1, flow restoration was complete in nine (60%) patients, partial in two (13.3%), and absent in four (26.7%). In Group 2, flow restoration was complete in seven (58.3%) patients, partial in three (25%), and absent in two (16.0%). The incidence of complete/partial recovery was similar in the groups. There was no difference between the two groups with regard to the duration of thrombus resolution. Fibrinolytic treatment was terminated in seven patients (46.7%) in Group 1, while in three patients (25%) in Group 2 due to the complications. The most common complications were minor or major bleedings. There was no statistically significant difference with regard to all bleedings complications between the two groups (P = .08), although the incidence of skin hemorrhages was higher in Group 1 (P = .007). There was no significant difference between the mortality rates. CONCLUSION: Even though the use of STK is not further recommended because of its potential undesirable side effects in newborns, its efficacy and safety appears to be similar to those of r-tPA.